You pay the standard rate for outpatient mental health services. You pay based on the allowed amount and the network status of the provider. Most outpatient mental health services do not require preauthorization. Visit the UMP Policies that affect your care webpage for a list of services that require plan notice. Your provider must notify the plan as soon as possible, but not later than 24 hours after the following services are initiated: • Intensive Outpatient Therapy • Partial Hospitalization Program (PHP) Substance use disorder Substance use disorder is defined as an illness characterized by a physiological or psychological dependency on a controlled substance or alcohol. Substance use disorder does not include dependence on tobacco, caffeine, or food. To be covered, treatment programs must be licensed to provide treatment to persons requiring substance use disorder treatment. The amount the plan pays depends on the provider’s network status (see the “Finding a health care provider” section and page 30). See above for details about coverage for mental health services. Contact UMP Customer Service about preauthorization requirements. Inpatient ALERT! Your provider must notify the plan as soon as possible after you are admitted to a facility, but not later than 24 hours after you are admitted when you receive inpatient services for substance use disorder treatment. If the plan is not notified of inpatient treatment, the plan may not cover the treatment. Inpatient treatment is subject to clinical review. You pay an inpatient copay for facility charges at a preferred facility (see the “Copay” section). Professional services (for example, doctors or lab tests) may be billed separately from the facility charges. The plan pays for these services according to the network status of the provider, unless it is for emergency services. Your provider must notify the plan when: • You receive detoxification services • You are admitted to a hospital • You are admitted to a residential treatment facility FOR MEDICARE RETIREES: The inpatient copay is $200 per day, with a maximum of $600 per inpatient admission, up to the medical out-of-pocket limit. Outpatient You pay the standard rate for outpatient substance use disorder treatment. You pay based on the allowed amount and the network status of the provider. Your provider must notify the plan when you receive the following services: • Detoxification • Intensive Outpatient Program (IOP) 2024 UMP Classic (PEBB) Certificate of Coverage 41